COVID-19 Vaccination for Foreign Residents of Chiang Mai: Second Dose

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This registration form is intended for those who still require COVID-19 vaccination in Chiang Mai and who fall into the following category:

Category 2: Foreign residents of Chiang Mai who had their first vaccination dose outside Chiang Mai and would like to have their second dose in Chiang Mai.

Data will be collected once a month, for 7 days starting on first Monday of each month.

All enquiries to Foreign Affairs, Chiang Mai Provincial Office: chiangmai.fa@gmail.com

(Your data will be protected and only used by Chiang Mai Provincial Health Office for the purpose of your COVID-19 Vaccination)

First Name *

Surname *

Date of Birth *

YYYY

Nationality *

Email Address *

Phone Number *

What District do you live in? *

What Sub-District do you live in? *

2.1 What was your first vaccine? *

Pfizer

AstraZeneca

2.2 Where did you receive your first vaccine dose? *

2.3 What date did you receive your first vaccine dose? *

YYYY

2.4 When is your second dose due? *

YYYY

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